The Mendelsohn Maneuver and its Effects on Swallowing: Kinematic Analysis in Three Dimensions Using Dynamic Area Detector CT

Inamoto, Yoko; Saitoh, Eiichi; Ito, Yuriko; Kagaya, Hitoshi; Aoyagi, Yoichiro; Shibata, Seiko; Ota, Kikuo; Fujii, Nobutaka; Palmer, Jeffrey B.

doi:10.1007/s00455-017-9870-7

Cited by 38 publications

(24 citation statements)

References 23 publications

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“…Inamoto and colleagues were able to perform a CT-based kinematic analysis of the swallowing act from the oral to the early oesophageal phase for the first time by using a scanner that enables the examination in a half-sitting position [ 103 ]. In initial studies, this technique was used to optimize the quantification of pharyngeal residues [ 104 ], to describe age-dependent changes in swallowing physiology [ 105 ] and to assess the influence of bolus volume [ 106 ], bolus viscosity [ 107 ] and swallowing maneuvers on the swallowing act [ 108 ].…”

Section: Diagnosticsmentioning

confidence: 99%

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Dziewas

Allescher

Aroyo

et al. 2021

Neurol. Res. Pract.

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Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

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Section: Diagnosticsmentioning

confidence: 99%

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Dziewas

Allescher

Aroyo

et al. 2021

Neurol. Res. Pract.

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“…Yellow shows Annular flow and blue shows Plug flow Typical flow patterns in vertical flow. Adapted from[9]. Blue is liquid, white is air and surrounded an inner core of moving air.…”

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confidence: 99%

Annular Flow in the Upper Esophageal Sphincter Demonstrated with Dynamic 320-row Area Detector Computed Tomography

2021

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Understanding bolus flow patterns in swallowing (rheology, the study of flow) is fundamental to assessment and treatment of dysphagia. These patterns are complex and poorly understood. A liquid swallow is typically biphasic, including air, so the actual bolus has both liquid and gas phases. We report a novel observation of annular two-phase flow (a ring of liquid around a core of air) as thin liquids passed through the upper esophageal sphincter (UES). Dynamic CT was performed on 27 healthy asymptomatic volunteers swallowing liquid barium in a semi-reclining position. Each subject swallowed 3, 10, and 20 ml of either thin (14 subjects) or thick liquid (13 subjects). Sagittal and axial images were analyzed. Flow patterns in the UES were assessed on cross-sectional images. Annular flow was seen in the majority of subjects with thin liquid but few with thick liquid swallows. The percentage of Annular flow during UES opening was 3 ml 58%, 10 ml 58%, 20 ml 56% in thin and 3 ml 0%, 10 ml 4%, 20 ml 1% in thick. Annular flow was usually observed from the second or third frames after onset of UES opening. The other pattern, Plug flow was seldom seen with thin but was typical with thick liquid swallows. Annular flow was the most common pattern for thin liquids (but not thick liquids) passing through the UES. Annular flow has been defined as a liquid continuum adjacent to the channel wall with a gas continuum (core) in the center of the channel. The two regions are demarcated by a gas-liquid interface. Annular flow is typical for two-phase gas-liquid flow in a vertical or inclined channel. It results from the interaction of viscosity with cohesive and adhesive forces in the two phases. We infer that the difference in flow pattern between thin liquid-air and thick liquid-air boluses resulted from the differing magnitudes of viscous forces.

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“…In addition to the movement parameters, supertasters had the shortest pharyngeal swallow phase duration (the time required to move the bolus through the pharynx), suggesting more efficient swallowing physiology than both mid-and nontasters. This may seem counterintuitive initially, and some studies have reported increased pharyngeal constriction to be associated with longer contraction of the relevant musculature (Inamoto et al, 2018;Molfenter et al, 2018). However, these findings involved within-subject comparisons of swallowing dynamics across varying conditions or cues that yielded different levels of effort in the swallows, i.e., the same basic motor plan executed to varying endpoints.…”

Section: Discussionmentioning

confidence: 99%

Genetic Taster Status as a Mediator of Neural Activity and Swallowing Mechanics in Healthy Adults

et al. 2019

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As part of a larger study examining relationships between taste properties and swallowing, we assessed the influence of genetic taster status (GTS) on measures of brain activity and swallowing physiology during taste stimulation in healthy men and women. Twenty-one participants underwent videofluoroscopic swallowing study (VFSS) and functional magnetic resonance imaging (fMRI) during trials of high-intensity taste stimuli. The precisely formulated mixtures included sour, sweet-sour, lemon, and orange taste profiles and unflavored controls. Swallowing physiology was characterized via computational analysis of swallowing mechanics plus other kinematic and temporal measures, all extracted from VFSS recordings. Whole-brain analysis of fMRI data assessed blood oxygen responses to neural activity associated with taste stimulation. Swallowing morphometry, kinematics, temporal measures, and neuroimaging analysis revealed differential responses by GTS. Supertasters exhibited increased amplitude of most pharyngeal movements, and decreased activity in the primary somatosensory cortex compared to nontasters and midtasters. These preliminary findings suggest baseline differences in swallowing physiology and the associated neural underpinnings associated with GTS. Given the potential implications for dysphagia risk and recovery patterns, GTS should be included as a relevant variable in future research regarding swallowing function and dysfunction.

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The Mendelsohn Maneuver and its Effects on Swallowing: Kinematic Analysis in Three Dimensions Using Dynamic Area Detector CT

Cited by 38 publications

References 23 publications

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Annular Flow in the Upper Esophageal Sphincter Demonstrated with Dynamic 320-row Area Detector Computed Tomography

Genetic Taster Status as a Mediator of Neural Activity and Swallowing Mechanics in Healthy Adults

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